Michigan is considering a package of changes aimed at easing health care shortages that lawmakers and advocates say are becoming more urgent as the state’s population ages. The proposals span who can provide care, what kinds of services they can deliver, and how licensing rules determine whether clinicians can practice across state lines.
At the center of the debate is scope-of-practice and licensing authority, including proposals involving nurse practitioners and other mid-level professionals, along with steps intended to speed up physician availability. Supporters of expanding roles say the state needs to “do something differently” to reach communities that lack providers, while opponents argue that current safeguards exist for patient safety and that loosening authority could create new risks.
AARP Michigan supports bills that would expand nurse practitioner roles and allow certain providers licensed in other states to practice in Michigan, an effort described as necessary by Jason Lachowski, the group’s associate state director of government affairs. “As Michigan ages, there’s ‘a larger need for health care,’” Lachowski said, adding that AARP Michigan represents 1.3 million members and backs legislation that would broaden practice access.
The proposals come as Michigan faces shortages across multiple parts of the health care system, from primary care physicians to psychiatrists and medical support roles, according to the AP reporting. The state’s public discussion also includes long-running workforce gaps in dentistry, where officials have sought ways to extend care to areas lacking enough dentists.
Misty Davis, who has been overseeing efforts at the Michigan Primary Care Association to place dental therapists in communities without sufficient access to dentists, said the problem requires changing how care is delivered. “If we are trying to open pathways for people in communities that need (to be) better served, we have to do something differently,” Davis said, describing the push to use dental therapists as part of the state’s response.
Alongside the support, Michigan doctors’ organizations and other medical groups have raised concerns about how expanded roles would affect patient care. Tom George, the CEO of the Michigan State Medical Society, said rules governing nurse practitioners and similar professionals are “outdated” in comparison to some other states, but he also argued that Michigan patients “deserve to have a physician available for their care.”
George said the way health care is organized is increasingly multidisciplinary, but he warned that patients could face confusion as terminology and licensing expands. He described patient navigation of the health care system as a “cloudy environment,” and he raised concerns that expanding roles for “mid-levels” such as nurse practitioners, physician’s assistants and dental therapists could confuse—and even endanger—patients.
Naila Russell, a nurse practitioner in Traverse City and the legislative chair for the Michigan Council of Nurse Practitioners, said Michigan’s controlled-substance rules remain a major barrier to practice. Russell said she cannot prescribe and dispense controlled substances without a doctor’s authority under existing law and explained that, in Michigan, nurse practitioners are still required to have “a delegating physician.” “We can’t operate in a rural setting where there are no physicians who will delegate to you,” she said, arguing that current restrictions limit access where provider coverage is already thin.
Russell’s comments focus on state law that restricts nurse practitioners from “full practice authority,” while other proposals being discussed would modify aspects of prescribing authority. The AP reporting describes lawmakers considering bills that would allow nurse practitioners to prescribe and dispense controlled substances without needing a doctor’s authority, among other proposals aimed at adding clinicians to the workforce more quickly.
George and physician advocates oppose multiple legislative efforts to grant nurse practitioners full practice authority. He argued that other states’ expanded scope of practice has “not made a dent” in making care more accessible, and he cited studies he said indicate that some independent nurse practitioners have taken on non-primary care roles such as cosmetic and IV hydration services.
George also pointed to reimbursement and cost concerns, saying nurse practitioners are reimbursed by Medicare at about 85% of a physician rate but that he is not convinced practice authority changes would save money. He described research he said shows costs rising in connection with nurse practitioners’ higher use of services such as imaging and referrals compared with doctors, and he called expanded opioid prescribing a “step backwards” for Michigan.
Even so, George said he is open to modifying the current regulation. “We’re at one extreme – we require supervision. And at the other extreme, you have total independence,” George said, calling for a more “flexible” written practice agreement that keeps doctors at the top of overseeing nurse practitioners rather than eliminating that oversight.
Outside the nurse practitioner debate, the state is also discussing other ways to bring more clinicians into service. The AP reporting describes proposed steps that include temporary licenses for some doctors who earned degrees outside the US or Canada, as well as Michigan joining interstate compacts intended to let providers licensed in other states practice in Michigan and allow Michigan-licensed clinicians to practice elsewhere.
For dentistry, the AP reporting describes an expansion of the use of other health care professionals such as dental therapists, a role that the state agreed to allow in 2008. Davis said the need is immediate, and the reporting describes the administrative and payment changes required to bring dental therapy work into practice, including rule-setting and Medicaid adjustments.
In nursing homes, the reporting describes the creation of a new role—medication aides—beginning in 2023, amid concerns that the industry is struggling with short staffing. The article also notes that Michigan’s first licensed dental therapist began working after the legislature approved the role in 2018, with administrative rules and Medicaid changes taking years to fully set up.
The AP story describes a training timeline that includes a program expected to start at Ferris State University after administrative groundwork is completed, along with statements that additional work remains before workforce expansion can move fully “boots on the ground.” In that context, lawmakers and advocates are pressing ahead with proposals that range from changing the licensing structure for clinicians to creating additional roles intended to reduce gaps in access.